Relative risks for exercise testing in children and adolescents

Lower risk	Higher risk
Symptoms during exercise in an otherwise healthy child who has a normal cardiorespiratory examination and normal ECG	Pulmonary hypertension
Exercise-induced bronchospasm in the absence of severe resting airways obstruction	Airways obstruction of less than moderate severity on baseline pulmonary function tests
Asymptomatic patients undergoing evaluation for possible long-QTc syndrome	Patients with documented long-QTc syndrome
Asymptomatic ventricular ectopy in patients with structurally normal hearts	History of a hemodynamically unstable arrhythmia
Unrepaired or residual congenital cardiac lesions without symptoms at rest, including: Left-to-right shunts (ASD, VSD, PDA, PAPVR) Obstructive right-heart lesions without severe resting obstruction (TS, PS, TOF) Obstructive left -eart lesions without severe resting obstruction (cor triatriatum, MS, AS, CoA) Regurgitant lesions regardless of severity	Dilated/restrictive cardiomyopathy with CHF or arrhythmia
Routine follow-up of asymptomatic patients at risk for myocardial ischemia, including: Kawasaki disease without giant aneurysms or known coronary stenosis After repair of anomalous LCA After arterial switch procedure	Hypertrophic cardiomyopathy associated with any of the following: Symptoms Greater than mild LVOTO Documented arrhythmia
Routine monitoring in cardiac transplant patients not currently experiencing rejection	Suspected myocardial ischemia with exertion
Patients with palliated cardiac lesions without uncompensated CHF, arrhythmia, or extreme cyanosis	Patients with Marfan syndrome and activity-related chest pain in whom a noncardiac cause of chest pain is suspected
Patients with a history of hemodynamically stable SVT	Routine testing of patients with Marfan syndrome
Patients with stable dilated cardiomyopathy without uncompensated CHF or documented arrhythmia	Unexplained syncope with exercise

ECG: electrocardiogram; ASD: atrial septal defect; VSD: ventricular septal defect; PDA: patent ductus arteriosus; PAPVR: partial anomalous pulmonary venous return; TS: tricuspid stenosis; PS: pulmonary stenosis; TOF, tetralogy of Fallot; MS: mitral stenosis; AS aortic stenosis; CoA: coarctation of aorta; CHF: congestive heart failure; LCA: left coronary artery; LVOTO: left ventricular outflow tract obstruction; SVT: supraventricular tachycardia.

Graphic 53217 Version 12.0

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Relative risks for exercise testing in children and adolescents